HomeMy WebLinkAboutFreeform Building Partners ELIZABETH A. NEV~.I,~,
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
:, _!~) ' ' OFFICE OF THE TOWN CLERK
J~"L s~p - 6 2~ i'5j TOWN OF SOUTHOLD
0 : 'S6iJt[t~ld TownjBuilding Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northf0rk.net
DATED:
Transmitted herewith is a copy of application No. 3506 for a Cesspool/Septic Tank Construction
Permit submitted by:
FreeForm Building Partners LIc.
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
Comments:
DISAPPROVE
Signature
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Telephone
(516} 765-1801
TOWN OF SOUTHOLD
Application No.
Construction
Alteration
$10.00 - Residential
$25.00 - Non-Residential
5OUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
· for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.~
DATE
APPLICANT ADDRESS: ~1~'~ ~,~ ~ ~,1~___..
DESCRIPTION OF P~OP~SED CONSTRUCTION OR ALTERATION
J
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section II~OD Block
cross STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED BY:
DATE:
Town Clerk's Office
'LOT° AREA = 83.771 SQ. FT.
F FL ELEV , 28.0
C-AR' ELEV 26.0
LOT ~IUN~ 4, -
8T41'2g''rc
(~.0)
NOTE LOT CLEARfNG SHALL BE LIMITED TO 1 ACRE
298.36'
EECEIVED
SUFFOLK
(24,.6)
R=85.00'
L--71.75'
15.08'
~T- 7/7/df ~I. RE,. Ho. /~/~ -'~ --o/~ ~
FOR MJ~I#u# OF ~ BZDROOliS
EXPIRES THREE YEARS FROM DATE OF' APPROVAL
(~.o)
N 73'05'20'1//
$05.61'
'NORTH BAYVIE ROAD
6 - 20 - 2005 REVtSE SANITARY SYSTEM
12-10-2004 RE'VlSI SANITARY
LOT N~ 5
~ OF Z~ ~N~ C~P.
~ 1' = ~' ~ 10-1~--~
ONLY TO:
HAROLD F. TRA.NCHON JR. PENN. MC. Ne. 211~-E
TAX ~ No.(RI:I~ 0NL~ 10OO-79--4,-P/O 17.17
HAROLD F, T~N JR. P.C.
P.O. ~X 6~
~B WA~ ~"ER-~ ~. WA~ ~ER,
83